Organization
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Active
Organization
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Active
Other names
NORTHERN WAYNE HEALTH CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FREDERICK JACKSON (EXECUTIVE DIRECTOR)
(570) 253-8450
Entity
Organization
Contact information
Practice address
412 COMO ROAD, LAKE COMO, PA 18437-0000
(570) 798-2828
(570) 798-2636
Mailing address
601 PARK ST, HONESDALE, PA 18431-1445
(570) 253-8226
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
OS011217
PA
207R00000X
Internal Medicine Physician
MD428487
PA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007765560005
—
PA
Enumeration date
12/03/2007
Last updated
04/07/2015
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